Tag: #pregnancy

Dr. Sunanda Kane discusses women with Crohn’s disease who want to get pregnant, issues around the time of birth, and breast feeding. Also discusses taking medications for Crohn’s disease during pregnancy and questions surrounding the chance of passing along Crohn’s disease to the baby.

A study found that, for healthy pregnancies, inducing labor after full term (39 weeks) rather than waiting for natural labor doesn’t increase the risk of major complications for newborns.

Being inside the womb for a full 39 weeks is important for a baby’s development. A baby’s brain nearly doubles in size during the last few weeks of pregnancy. The lungs and liver are still developing too.

Once a woman has reached full term, her doctor may suggest inducing labor for different medical, or non-medical, reasons. Sometimes the mother will request an induced labor if she’s uncomfortable in her final weeks.

Prior research has shown that inducing labor before 39 weeks of pregnancy puts the baby at risk of serious health problems. Researchers wanted to find out if inducing labor at full term also puts a baby at risk of serious health problems. They also wondered if it increases a woman’s chance of needing a surgery called a cesarean section, or C-section.

The team enrolled 6,000 pregnant women in the study. Participants were randomly assigned to two groups. Half of the women waited to have a natural labor. The other half were induced at 39 weeks.

The two groups of babies had similar survival rates and chances of serious health problems, such as needing help with breathing, having a seizure, or getting an infection. Inducing labor also reduced the mothers’ chance of a C-section and lowered their blood pressure.

“Induction at 39 weeks should not be routine for every woman, but it’s important to talk with their provider and decide if they want to be induced and when,” says study leader Dr. William Grobman of Northwestern University.

International Fetal Alcohol Spectrum Disorders (FASD) Awareness Day, recognized every year on Sept. 9th, is an important reminder prenatal alcohol exposure is the leading preventable cause of birth defects and developmental disorders in the United States. Almost 40 years have passed since it was recognized drinking during pregnancy can result in a wide range of disabilities for children, of which fetal alcohol syndrome (FAS) is the most severe. Still, 1 in 13 pregnant women report drinking in the past 30 days. Of those, about 1 in 6 report binge drinking during that time.

The disabilities associated with FASD can persist throughout life and place heavy emotional and financial burdens on individuals, their families, and society. Alcohol use during pregnancy can cause physical, behavioral, and intellectual disabilities. Often, a person with an FASD has a mix of these problems. It is recommended women who are pregnant or might be pregnant not drink alcohol. Fetal alcohol spectrum disorders are completely preventable if a developing baby is not exposed to alcohol before birth.

What We Know

Women who are pregnant or who might be pregnant should be aware that any level of alcohol use could harm their babies.

All types of alcohol can be harmful, including all wine and beer.

The baby’s brain, body, and organs are developing throughout pregnancy and can be affected by alcohol at any time.

Alcohol use during pregnancy can also increase the risk of miscarriage, stillbirth, preterm (early) birth, and sudden infant death syndrome (SIDS).

Cause and Prevention

FASDs are caused by a woman drinking alcohol during pregnancy. Alcohol in the mother’s blood passes to the baby through the umbilical cord. When a woman drinks alcohol, so does her baby.

There is no known safe amount of alcohol during pregnancy or when trying to get pregnant. There is also no safe time to drink during pregnancy. Alcohol can cause problems for a developing baby throughout pregnancy, including before a woman knows she’s pregnant. All types of alcohol are equally harmful, including all wines and beer.

To prevent FASDs, a woman should not drink alcohol while she is pregnant, or when she might get pregnant. This is because a woman could get pregnant and not know for up to 4 to 6 weeks. In the United States, nearly half of pregnancies are unplanned.

If a woman is drinking alcohol during pregnancy, it is never too late to stop drinking. Because brain growth takes place throughout pregnancy, the sooner a woman stops drinking the safer it will be for her and her baby. Resources are available here.

FASDs are completely preventable if a woman does not drink alcohol during pregnancy—so why take the risk?

Signs and Symptoms

FASDs refer to the whole range of effects that can happen to a person whose mother drank alcohol during pregnancy. These conditions can affect each person in different ways and can range from mild to severe.

A person with an FASD might have:

Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)

Small head size

Shorter-than-average height

Low body weight

Poor coordination

Hyperactive behavior

Difficulty with attention

Poor memory

Difficulty in school (especially with math)

Learning disabilities

Speech and language delays

Intellectual disability or low IQ

Poor reasoning and judgment skills

Sleep and sucking problems as a baby

Vision or hearing problems

Problems with the heart, kidneys, or bones

Types of FASDs

Different terms are used to describe FASDs, depending on the type of symptoms.

Fetal Alcohol Syndrome (FAS): FAS represents the most involved end of the FASD spectrum. Fetal death is the most extreme outcome from drinking alcohol during pregnancy. People with FAS might have abnormal facial features, growth problems, and central nervous system (CNS) problems. People with FAS can have problems with learning, memory, attention span, communication, vision, or hearing. They might have a mix of these problems. People with FAS often have a hard time in school and trouble getting along with others.

Alcohol-Related Neurodevelopmental Disorder (ARND): People with ARND might have intellectual disabilities and problems with behavior and learning. They might do poorly in school and have difficulties with math, memory, attention, judgment, and poor impulse control.
Alcohol-Related Birth Defects (ARBD): People with ARBD might have problems with the heart, kidneys, or bones or with hearing. They might have a mix of these.

Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): ND-PAE was first included as a recognized condition in the Diagnostic and Statistical Manual 5 (DSM 5) of the American Psychiatric Association (APA) in 2013. A child or youth with ND-PAE will have problems in three areas: (1) thinking and memory, where the child may have trouble planning or may forget material he or she has already learned, (2) behavior problems, such as severe tantrums, mood issues (for example, irritability), and difficulty shifting attention from one task to another, and (3) trouble with day-to-day living, which can include problems with bathing, dressing for the weather, and playing with other children. In addition, to be diagnosed with ND-PAE, the mother of the child must have consumed more than minimal levels of alcohol before the child’s birth, which APA defines as more than 13 alcoholic drinks per month of pregnancy (that is, any 30-day period of pregnancy) or more than 2 alcoholic drinks in one sitting.

Diagnosis

The term FASDs is not meant for use as a clinical diagnosis. CDC worked with a group of experts and organizations to review the research and develop guidelines for diagnosing FAS. The guidelines were developed for FAS only. CDC and its partners are working to put together diagnostic criteria for other FASDs, such as ARND. Clinical and scientific research on these conditions is going on now.

Diagnosing FAS can be hard because there is no medical test, like a blood test, for it. And other disorders, such as ADHD (attention-deficit/hyperactivity disorder) and Williams syndrome, have some symptoms like FAS.

Central nervous system problems (e.g., small head size, problems with attention and hyperactivity, poor coordination)

Prenatal alcohol exposure; although confirmation is not required to make a diagnosis

Treatment

FASDs last a lifetime. There is no cure for FASDs, but research shows early intervention treatment services can improve a child’s development.

There are many types of treatment options, including medication to help with some symptoms, behavior and education therapy, parent training, and other alternative approaches. No one treatment is right for every child. Good treatment plans will include close monitoring, follow-ups, and changes as needed along the way.

Also, “protective factors” can help reduce the effects of FASDs and help people with these conditions reach their full potential. These include:

Diagnosis before 6 years of age

Loving, nurturing, and stable home environment during the school years

Absence of violence

Involvement in special education and social services

What Can Be Done to Prevent Fetal Alcohol Spectrum Disorders

Women Can

Talk with their healthcare providers about their plans for pregnancy, their alcohol use, and ways to prevent pregnancy if they are not planning to get pregnant.

Stop drinking alcohol if they are trying to get pregnant or could get pregnant.

Ask their respective partners, families, and friends to support their choice not to drink during pregnancy or while trying to get pregnant.

Ask their healthcare providers or other trusted people about resources for help if they cannot stop drinking on their own.

Healthcare providers can

Screen all adult patients for alcohol use at least yearly.

Advise women not to drink at all if there is any chance they could be pregnant.

Counsel, refer, and follow up with patients who need more help.

Use the correct billing codes so that alcohol screening and counseling is reimbursable.

Get Help!

If you or the doctor thinks there could be a problem, ask the doctor for a referral to a specialist (someone who knows about FASDs), such as a developmental pediatrician, child psychologist, or clinical geneticist. In some cities, there are clinics whose staffs have special training in diagnosing and treating children with FASDs. To find doctors and clinics in your area visit the National and State Resource Directory from the National Organization on Fetal Alcohol Syndrome (NOFAS).

At the same time as you ask the doctor for a referral to a specialist, call your state’s early intervention program to request a free evaluation to find out if your child can get services to help. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child’s age:

If your child is younger than 3 years old, Call your state or territory’s early intervention program and say: “I have concerns about my child’s development and I would like to have my child evaluated to find out if he/she is eligible for early intervention services.”

If your child is 3 years old or older, contact your local public school system. Even if your child is not old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.

Conclusion

Research to understand how alcohol exposure during pregnancy interferes with fetal development and how FASD can be identified and prevented is ongoing. Scientists continue to make tremendous strides, providing important new insights into the nature of FASD and potential intervention and treatment strategies.

The message is simple, not just on Sept. 9, but every day. There is no known safe level of drinking while pregnant. Women who are, who may be, or who are trying to become pregnant, should not drink alcohol.

If you or pregnant, may become pregnant, or are a new parent wondering about the effects of alcohol on your child, find a caring physician who can advise you using the first of its kind social ecosystem for HealthCare. At HealthLynked, your can connect with providers in new and unique ways to collaborate on your wellness and the health of your family.

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2. Hormonal birth control

Birth control pills may cause spotting between periods and result in much lighter periods.

An IUD may cause heavy bleeding.

3. Breastfeeding

Prolactin is a hormone that’s responsible for breast milk production. Prolactin suppresses your reproductive hormones resulting in very light periods or no period at all while you’re breastfeeding.

Your periods should return shortly after you stop breastfeeding. Read on to learn more the effects of breastfeeding on your period.

4. Perimenopause

Perimenopause is the transition phase before you enter menopause. It usually begins in your 40s, but can occur earlier.

You may experience signs and symptoms lasting from 4 to 8 years, beginning with changes to your menstrual cycle. Fluctuating estrogen levels during this time can cause your menstrual cycles to get longer or shorter.

Other signs and symptoms of perimenopause include:

hot flashes

night sweats

mood changes

difficulty sleeping

vaginal dryness

5. Polycystic ovary syndrome (PCOS)

Irregular periods are the most common sign of PCOS. If you have PCOS, you may miss periods and have heavy bleeding when you do get your period.

PCOS can also cause:

infertility

excess facial and body hair

male-pattern baldness

weight gain or obesity

6. Thyroid problems

An underactive thyroid may cause longer, heavier periods.

A 2015 study found that 44 percent of participants with menstrual irregularities also had thyroid disorders.

Hypothyroidism, or underactive thyroid, can cause longer, heavier periods and increased cramping. You may also experience fatigue, sensitivity to cold, and weight gain.

High levels of thyroid hormones, which is seen in hyperthyroidism, can cause shorter, lighter periods. You may also experience:

sudden weight loss

anxiety and nervousness

heart palpitations

Swelling at the base of your neck is another common sign of a thyroid disorder.

7. Uterine fibroids

Fibroids are muscular tumors that develop in the wall of the uterus. Most fibroids are noncancerous and can range in size from as small as an apple seed to the size of a grapefruit.

Fibroids can cause your periods to be very painful and heavy enough to cause anemia. You may also experience:

pelvic pain or pressure

low back pain

pain in your legs

pain during sex

Most fibroids don’t require treatment and symptoms can be managed with over-the-counter (OTC) pain medications and an iron supplement if you develop anemia.

8. Endometriosis

Endometriosis affects 1 in 10 women of reproductive age. This is a condition in which the tissue that normally lines your uterus grows outside the uterus.

Exploratory surgery is the only way to diagnose endometriosis. There’s currently no cure for the condition, but symptoms can be managed with medication or hormone therapy.

9. Being overweight

Obesity is known to cause menstrual irregularity. Research shows that being overweight impacts hormone and insulin levels, which can interfere with your menstrual cycle.

Rapid weight gain can also cause menstrual irregularities. Weight gain and irregular periods are common signs of PCOS and hypothyroidism, and should be evaluated by your doctor.

10. Extreme weight loss and eating disorders

Excessive or rapid weight loss can cause your period to stop. Not consuming enough calories can interfere with the production of the hormones needed for ovulation.

You’re considered underweight if you have a body mass index lower than 18.5. Along with stopped periods, you may also experience fatigue, headaches, and hair loss.

See your doctor if:

you’re underweight

have lost a lot of weight without trying

you have an eating disorder

11. Excessive exercise

Intense or excessive exercise has been shown to interfere with the hormones responsible for menstruation.

Female athletes and women who participate in intensive training and physical activities, such as ballet dancers, often develop amenorrhea, which is missed or stopped periods.

Cutting back on your training and increasing your calorie count can help restore your periods.

12. Stress

Research shows that stress can interfere with your menstrual cycle by temporarily interfering with the part of the brain that controls the hormones that regulate your cycle. Your periods should return to normal after your stress decreases. Try these 16 techniques to relieve your stress.

14. Cervical and endometrial cancer

Cervical and endometrial cancers can cause changes to your menstrual cycle, along with bleeding between periods or heavy periods. Bleeding during or after intercourse and unusual discharge are other signs and symptoms of these cancers.

Remember that these symptoms are more commonly caused by other issues. Speak to your doctor if you’re concerned.

When to call your healthcare provider

There are several possible causes of irregular periods, many of which require medical treatment. Make an appointment to see your doctor if:

your periods stop for more than 3 months and you’re not pregnant

your periods become irregular suddenly

you have a period that lasts longer than 7 days

you need more than one pad or tampon every hour or two

you develop severe pain during your period

your periods are less than 21 days or more than 35 days apart

you experience spotting between periods

you experience other symptoms, such as unusual discharge or fever

Your doctor will ask about your medical history and want to know about:

any stress or emotional issues you’re experiencing

any changes to your weight

your sexual history

how much you exercise

Medical tests may also be used to help diagnose the cause of your irregular bleeding, including:

a pelvic examination

blood tests

abdominal ultrasound

pelvic and transvaginal ultrasound

CT scan

MRI

Treatments

Treatment depends on what’s causing your irregular periods and may require treating an underlying medical condition. Your doctor may recommend one or more of the following treatments:

when your bleeding begins and whether or not it was earlier or later than expected

how heavy your bleeding was, including how many pads or tampons you used

symptoms during your period, such as cramping, back pain, and other symptoms and how bad they were

how long your period lasted and whether or not it was longer or shorter than your last period

Outlook

Irregular periods can be caused by a number of things, some of them serious. Your doctor can help you determine the cause and help you get your cycle back on track. Eating a balanced diet, getting regular exercise, and avoiding stress can also help.

Good Morning America’s Robin Roberts and WebMD have partnered on a new series about The Future of Health. We’ll take you inside some of the most exciting medical breakthroughs to meet the innovators and patients helping to transform the lives of millions of people. See the full report: http://wb.md/1Eaa65G

What We Know About Medicine Use in Pregnancy

Almost every pregnant woman will face a decision about taking medicines before and during pregnancy. However, we know little about the effects of taking most medicines in pregnancy because pregnant women are often not included in studies that determine the safety of new medicines. We do know

9 in 10 women report taking some type of medicine during pregnancy, and 7 in 10 report taking at least one prescription medicine. Over the last 30 years, women’s use of prescription medicines during the first trimester (first 3 months) of pregnancy increased by more than 60%;1

Many women need to take medicines during pregnancy to control their health conditions. In some cases, avoiding or stopping a medicine during pregnancy may be more harmful than taking that medicine;

At the same time, we know that taking certain medicines during pregnancy can increase the risk for birth defects, pregnancy loss, prematurity, infant death, or developmental disabilities; and

The effects of medicine on you and your baby may depend on many factors, such as

How much medicine you take (sometimes called the dose),

When during the pregnancy you take the medicine,

Other health conditions you have, and

Other medicines you take.

Have a Healthy Pregnancy

Is it safe for me to take medicines before I get pregnant?

If you are trying to have a baby or are just thinking about it, it is not too early to start getting ready for pregnancy. Many women need to take medicine to stay healthy during pregnancy. If you are planning to become pregnant, you should discuss your current medicines with a healthcare provider, such as your doctor or pharmacist. Some medicines can cause birth defects very early in pregnancy, often before you even know you are pregnant. Creating a treatment plan for your health condition before you are pregnant can help keep you and your developing baby healthy.

I need to take a medicine while pregnant. What do I do?

If you are pregnant, talk with a healthcare professional about any medicines you have taken or are thinking of taking. You should go over all prescriptions, over-the-counter medicines, herbal and dietary supplements, and vitamins. The FDA’s Office of Women’s Health developed a tool in English and Spanish to help you keep a record of the medicines you take. Although no medicine is completely risk-free, a healthcare professional, such as a doctor or pharmacist, can help you pick a treatment plan that works for you. You should not start any new medicines or stop a current medicine without talking to a healthcare professional.

You might need to take medicines to treat a health condition. For example, if you have asthma, epilepsy, high blood pressure, or depression, you may need to take medicines to stay healthy during pregnancy. Some untreated health conditions may actually be more harmful than the medicines used to control them. However, we know that some medicines can increase the risk of birth defects, pregnancy loss, prematurity, infant death, or developmental disabilities. A healthcare professional can help you weigh the risks and benefits of each medicine and determine the safest treatment for you and your developing baby.

Good Medicine Can Be Bad for Baby Podcast

Listen to an expert discuss why you should talk to a healthcare professional about the medicines you take during pregnancy.

I took a medicine before I knew I was pregnant. What do I do?

If you took medicines before you learned you were pregnant, you may want to talk with a healthcare professional about any concerns you may have. Some medicines can be harmful when taken during pregnancy, but others are unlikely to cause harm. If you are concerned and cannot reach your doctor, you can contact an expert for free through email, text, call, or live chat on the MotherToBaby website.

Should I trust online information about medicine safety in pregnancy?

Use caution when consulting online sources about medicine safety in pregnancy– instead, use this information to start a conversation with a healthcare professional. Many websites post lists of medicines that are “safe” to take during pregnancy. However, for many medicines listed, there is not enough scientific evidence of their safety during pregnancy.

Take caution when watching online videos as well. A 2015 study found that content in current YouTube videos does not accurately describe the safety of specific medicines used during pregnancy. This is an important reason for you to talk with a healthcare professional about potential risks of using medicines during pregnancy.

Can I take medicine once I’m no longer pregnant?

After pregnancy, keep you and your baby healthy by talking with a healthcare professional, such as a doctor or pharmacist, about the medicines you are thinking of taking. LactMed is an online database that provides information about specific medicines, ways they might affect you or your baby, and potential alternatives to consider. Information in this database can help guide the conversation with your healthcare professional about managing your health condition while breastfeeding.

How You Can Help

We know little about the effects of taking most medicines in pregnancy, because pregnant women are often not included in studies that determine the safety of new medicines. As a result, women and healthcare professionals have limited information about the safety of most medicines – especially newer medicines— in pregnancy.

Treating for Two and its partners are gathering new information on medicines taken during pregnancy and how medicines might affect the pregnancy.

You can help improve the evidence on medicines and pregnancy by doing the following:

Enroll in a pregnancy registry. Pregnancy registries are systems for tracking outcomes in pregnant women who take a particular medicine. After these women give birth, researchers compare the health of their babies with the babies of women who did not take the medicine. Pregnancy registries are a useful way to study the effects of a particular medicine and gather health information during pregnancy and after delivery. For a list of current pregnancy registries and how to enroll, visit the FDA Pregnancy Registry website.

Sign up for a research study. Help researchers find answers about the safety of medicines during pregnancy by signing up for a MotherToBaby Pregnancy Study. If you choose to join a study, you will not be asked to take any medicines or vaccines or change any part of your routine. To see if you are eligible, visit the MotherToBaby website or call (877) 311-8972 (Toll-Free).

Additional Resources

Many organizations are committed to understanding more about medicines and pregnancy and providing helpful resources for women and healthcare providers.

LactMed
Hosted by the National Library of Medicine, LactMed is a database that contains information about specific medicines, ways they might affect breastfeeding mothers and their babies, and potential alternatives to consider, if needed.

March of Dimes
This webpage provides information related to the use of medicines and herbal products during pregnancy.

MotherToBaby
MotherToBaby provides information and fact sheets, in English and Spanish, on the risks and safety of taking specific medicines during pregnancy and breastfeeding. To speak with a MotherToBaby counselor about the safety of a medicine you have taken or you are thinking of taking, call 1-866-626-6847. This service is free and confidential.

Mayo Clinic cardiovascular surgeon, Joseph Dearani, M.D., talks about the diagnosis and treatment of Ebstein’s anomaly. Visit http://www.mayoclinic.org/diseases-conditions/ebsteins-anomaly/home/ovc-20199183?mc_id=global&utm_source=youtube&utm_medium=sm&utm_content=cardiacanomalyheart&utm_campaign=mayoclinic&geo=global&placementsite=enterprise&cauid=10394 for more information on Ebstein’s anomaly or to request an appointment at Mayo Clinic.

Ebstein’s anomaly is a congenital heart defect that can differ from patient to patient. An Ebstein’s anomaly patient who is highly symptomatic can require urgent surgery as a newborn while others may not know they have this condition until late into adulthood. However, with advances in prenatal ultrasounds, this diagnosis can oftentimes be made prenatally. The timing of surgical treatment for Ebstein’s anomaly can vary depending on severity of the diagnosis as well as other compounding factors such as a hole in the heart or cyanosis.

The ultimate goal of surgical treatment for Ebstein’s anomaly is to repair the native tricuspid valve. If the tricuspid valve is too abnormal to repair, replacement is also an option. Patients who have undergone tricuspid valve repair or replacement for Ebstein’s anomaly require continuous followup for things such as irregular heartbeats, arrhythmias, recurrent tricuspid valve problems, and ventricular function abnormalities.

Women who smoke during pregnancy are more likely than other women to have a miscarriage.

Smoking can cause problems with the placenta—the source of the baby’s food and oxygen during pregnancy. For example, the placenta can separate from the womb too early, causing bleeding, which is dangerous to the mother and baby.

Smoking during pregnancy can cause a baby to be born too early or to have low birth weight—making it more likely the baby will be sick and have to stay in the hospital longer. A few babies may even die.

What are e-cigarettes? Are they safer than regular cigarettes in pregnancy?

Electronic cigarettes (also called electronic nicotine delivery systems or e-cigarettes) come in different sizes and shapes, including “pens,” “mods,” (i.e., these types are modified by the user) and “tanks.” Most e-cigarettes contain a battery, a heating device, and a cartridge to hold liquid. The liquid typically contains nicotine, flavorings, and other chemicals. The battery-powered device heats the liquid in the cartridge into an aerosol that the user inhales.

Although the aerosol of e-cigarettes generally has fewer harmful substances than cigarette smoke, e-cigarettes and other products containing nicotine are not safe to use during pregnancy. Nicotine is a health danger for pregnant women and developing babies and can damage a developing baby’s brain and lungs. Also, some of the flavorings used in e-cigarettes may be harmful to a developing baby. Learn more about e-cigarettes and pregnancy.

Quitting Smoking Can Be Hard, But It Is One of the Best Ways a Woman Can Protect Herself and Her Baby’s Health

Breathing other people’s smoke make children and adults who do not smoke sick. There is no safe level of breathing others people’s smoke.

Pregnant women who breathe other people’s cigarette smoke are more likely to have a baby who weighs less.

Babies who breathe in other people’s cigarette smoke are more likely to have ear infections and more frequent asthma attacks.

Babies who breathe in other people’s cigarette smoke are more likely to die from Sudden Infant Death Syndrome (SIDS). SIDS is an infant death for which a cause of the death cannot be found.

In the United States, 58 million children and adults who do not smoke are exposed to other people’s smoke. Almost 25 million children and adolescents aged 3–19 years, or about 4 out of 10 children in this age group, are exposed to other people’s cigarette smoke. Home and vehicles are the places where children are most exposed to cigarette smoke, and a major location of smoke exposure for adults too. Also, people can be exposed to cigarette smoke in public places, restaurants, and at work.

What Can You Do to Avoid Other People’s Smoke?

There is no safe level of exposure to cigarette smoke. Breathing even a little smoke can be harmful. The only way to fully protect yourself and your loved ones from the dangers of other people’s smoke is through 100% smoke-free environments.

You can protect yourself and your family by

Making your home and car smoke-free.

Asking people not to smoke around you and your children.

Making sure that your children’s day care center or school is smoke-free.

Choosing restaurants and other businesses that are smoke-free. Thanking businesses for being smoke-free.

Teaching children to stay away from other people’s smoke.

Avoiding all smoke. If you or your children have respiratory conditions, if you have heart disease, or if you are pregnant, the dangers are greater for you.

Learn as much as you can by talking to your doctor, nurse, or health care provider about the dangers of other people’s smoke.